Reader response: Lipid levels and the risk of hemorrhagic stroke among women
Laurens F.Reeskamp, MD, PhD Candidate, Department of Vascular Medicine, Amsterdam UMC
, MD, PhD Candidate, Department of Vascular Medicine, Amsterdam UMC
Published July 01, 2019
Rist et al. showed that patients with low-density lipoprotein cholesterol (LDL-C) levels <70 mg/dL are at increased risk of intracranial hemorrhage (ICH).1 While fully acknowledging their results, we, however, deem a full appreciation of the clinical relevance of these numbers to be pivotal. Since LDL-C levels are causally related to cardiovascular disease (CVD) risk, findings should be balanced against the relative contribution of LDL-C in CVD risk in the study population. The Cholesterol Treatment Trialists’ Collaboration showed that every 10 mg/dL lowering of LDL-C reduces the annual CVD-risk by 1.03%.2 The overall CVD-risk in this cohort is reported to be 0.25% per year.3 We estimate that the low LDL-C group (<70 mg/dL) has a CVD-risk of 0.24% per year (53.7 mg/dL LDL-cholesterol below median in this cohort).3 The reported annual risk for ICH in the low LDL-C group is 0.04%. Therefore, the risk for CVD is approximately 6 times higher than the risk for ICH in this group.
Disclosures
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References
Rist PM, Buring JE, Ridker PM, et al. Lipid levels and the risk of hemorrhagic stroke among women. Neurology 2019;92:e2286–e2294.
Cholesterol Treatment Trialists’ (CTT) Collaboration, Baigent C, Blackwell L, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: A meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 2010;376:1670–1681.
Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. Comparison of C-Reactive Protein and Low-Density Lipoprotein Cholesterol Levels in the Prediction of First Cardiovascular Events. N Engl J Med 2002;347:1557–1565.
Rist et al. showed that patients with low-density lipoprotein cholesterol (LDL-C) levels <70 mg/dL are at increased risk of intracranial hemorrhage (ICH).1 While fully acknowledging their results, we, however, deem a full appreciation of the clinical relevance of these numbers to be pivotal. Since LDL-C levels are causally related to cardiovascular disease (CVD) risk, findings should be balanced against the relative contribution of LDL-C in CVD risk in the study population. The Cholesterol Treatment Trialists’ Collaboration showed that every 10 mg/dL lowering of LDL-C reduces the annual CVD-risk by 1.03%.2 The overall CVD-risk in this cohort is reported to be 0.25% per year.3 We estimate that the low LDL-C group (<70 mg/dL) has a CVD-risk of 0.24% per year (53.7 mg/dL LDL-cholesterol below median in this cohort).3 The reported annual risk for ICH in the low LDL-C group is 0.04%. Therefore, the risk for CVD is approximately 6 times higher than the risk for ICH in this group.
Disclosures
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References